1346290863 NPI number — DR. JAIME AUGUSTO ALTAMIRANO M.D.

Table of content: DR. JAIME AUGUSTO ALTAMIRANO M.D. (NPI 1346290863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346290863 NPI number — DR. JAIME AUGUSTO ALTAMIRANO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALTAMIRANO
Provider First Name:
JAIME
Provider Middle Name:
AUGUSTO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346290863
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 566210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33256-6210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-227-1733
Provider Business Mailing Address Fax Number:
305-227-3151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11760 SW 40TH ST
Provider Second Line Business Practice Location Address:
SUITE 335
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33175-3595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-227-1733
Provider Business Practice Location Address Fax Number:
305-227-3151
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  ME45612 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2609258-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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